Komeza Kwishyura Medicare Kuvura Kwita ku Barwayi? Inyandiko Yuzuye

Komeza kwishyura Medicare kuvura kwita ku barwayi? Nta gihe ntarengwa ku giti cye kuri serivisi ya Medicare hospice. Igihe cyose ukomeje guhuza ibisabwa ku burwayi bwa burundu, Medicare yishyura hospice ubuziraherezo. Serivisi igenewe ibihe byihariye (ibihe bibiri bya minsi 90, hanyuma ibihe bitagira umupaka bya minsi 60) hamwe no gusubiramo kwemeza bisabwa ku ntangiriro ya buri gihe. Abarwayi benshi bahabwa hospice amezi menshi. Bamwe babihabwa igihe kirekire cyane iyo imiterere yabo ikomeje kuba ikwiye hospice. "Itegeko ry'amezi 6" rivugwa kenshi rivuga ubwoba busabwa kugirango uhabwe ubujyanama bwambere, aho kuba igihe ntarengwa cyo kwivuza.

Iyi nshingano yerekana uko ibihe bya Medicare hospice bikora, igihe gusubiramo kwemeza bibaho, icyo biba iyo imiterere yawe yoroheje, n'icyo imiryango igomba kumenya kubijyanye n'igihe. Amakuru avuye kuri CMS, Medicare.gov, n'ishyirahamwe rya Hospice n'ubuvuzi bw'abarwayi bo mu gihugu.

Igikoresho cy'ibinyagihugu 90/90/60

Igikoresho cya Medicare hospice gikoreshwa mu bihe byihariye:

• Igihe cya mbere cyo guhabwa serivisi: iminsi 90

• Igihe cya kabiri cyo guhabwa serivisi: iminsi 90

• Igihe cya gatatu cyo guhabwa serivisi n'ibindi: ibihe bitagira umupaka bya minsi 60

Nta mibare ntarengwa y'ibihe byo guhabwa serivisi. Igihuje n'ubushobozi bw'umuganga wa hospice ko ukomeje kuba urwaye burundu mu ntangiriro ya buri gihe gishya, serivisi irakomeza nta gucikanwa.

Kudasobanukirwa bisanzwe: ubwoba busabwa bwa "amezi 6 cyangwa munsi" kugirango uhabwe ubujyanama bwambere ntibisobanura ko Medicare ihagarara kwishyura nyuma y'amezi 6. Irindi jambo rivuga ibisabwa ku buryo burwayi kugirango uhabwe ubujyanama, aho kuba igihe ntarengwa cyo kwivuza. Bamwe abarwayi babaho igihe kirekire kuruta uko bitegwaga, kandi igihe cyose umuganga wa hospice akomeje kwemeza ko bafite uburwayi burundu, hospice irakomeza.

Nk'uko amakuru ya Medicare abivuga, uburebure busanzwe bwo kuba mu bitaro ni iminsi 18. Ahagana kuri 30% by'abarwayi ba hospice bahabwa ubuvuzi mu minsi 7 cyangwa munsi yayo. Kuri 10% bahabwa hospice mu mezi 6 cyangwa irenga. Iri tananira ryerekana kutagaragara k'ubuzima bw'uburwayi burundu aho kuba ubushake bwa Medicare bwo kwivuza igihe kirekire.

Gusubiramo Kwemeza: Ni Gute Medicare Yemeza Ko Ukomeje Kuba Ikwiye

Mu ntangiriro ya buri gihe cyo guhabwa serivisi, umuganga wa hospice cyangwa umuganga wa hospice agomba kwemeza ko ukomeje kuba urwaye burundu (ubuzima bufite iminsi 6 cyangwa munsi y'iyo uburwayi bukora uko bisanzwe).

Ku gihe cya gatatu cyo guhabwa serivisi n'ibindi bihe byose, hakenewe guhurana n'umuganga wa hospice cyangwa umuganga w'umuganga utwite byibuze iminsi 30 mbere y'intangarugero ya buri gihe cyo guhabwa serivisi. Ibi bisabwa byo guhurana byongeyeho na Affordable Care Act mu 2011 kugirango hahise uburyo bwo kwemeza ko ibyo uba ukwiriye kwivuza byemezwa na muganga, aho kuba ibijyanye n'inyandiko gusa.

Inzira yo gusubiramo kwemeza ni inzira y'ubuyobozi ku ruhande rwa hospice. Abarwayi n'imiryango ntibajya bakubona gusubiramo nk'igikorwa cy'igenamigambi. Umuforomo wa hospice cyangwa umukozi ufite imibereho myiza asura kenshi, kandi inyandiko zo gusubiramo kwemeza zikora inyuma.

Ibyo abarwayi n'imiryango babona:

• Uburyo bwo kwita budacika intege budacibwamo.

• Itsinda rya hospice rikomeza imirimo yose.

• Icyubahiro n'ikimwaro bikomeza kuba intego.

• Umu plan y'ubuvuzi ihinduka uko imiterere y'umubiri ihinduka.

Kugirango ubone ibisobanuro kubijyanye n'ibyo Medicare hospice ikubiyemo (serivisi yuzuye), reba ubuyobozi bwacu bwo bwo kwita ku barwayi kwa Medicare.

Biteho Niba Imiterere Yawe Yoroheje?

Urugero runini rw'abarwayi ba hospice baroroheje bihagije kugirango badakomeza kuba bakwiye hospice. Ibi rimwe na rimwe bibaho kubera ko kugenzura neza ibimenyetso no kugabanya stress byemerera umubiri kwishimikira, cyane cyane ku ndwara zikomeye nk'indwara y'umutima irushijeho cyangwa COPD yo mu rwego rwo hejuru.

Niba umuganga wa hospice yasanze udahuje ibisabwa ku burwayi bwa burundu, itsinda rya hospice rizakuramo kubera ko ufite gahunda yo "kwivuza utarashize". Ibi si ingorane. Ni ikimenyetso ko ubuzima bw'ubu bw'ubu buraboneka mu buryo butunguranye.

Inzira yo kwivuza utarashize:

• Hospice itanga impapuro zisobanura impamvu ubujyanama budakiriho.

• Ugaruka ku kwivuza kwa Medicare bisanzwe kubitaru n'ibitaru bidafitanye isano.

• Urashobora kwinjira muri hospice ugasubira mu gihe imiterere yawe yongeye kumanuka.

• Ntiwambura serivisi y'ubutabazi ya hospice y'ubutazazaza.

Kuri 17% by'abarwayi ba Medicare hospice baravurwa buri mwaka, nk'uko amakuru ya CMS abivuga. Impamvu nyamukuru zirimo kwishyurwa kw'imiterere (cyane cyane), icyemezo cy'umuganga wo gukomeza ubuvuzi bwo gukiza, kwimurwa mu cyicaro kidafite hospice, cyangwa kwemeza ko utari mukwiye kubusubiramo.

Kwirinda bushake: guhagarara hospice ku mahirwe yawe

Abarwayi bashobora guhagarika hospice igihe icyo ari cyo cyose, ku mpamvu iyo ari yo yose. Guhagarika hospice bigarura ako kanya ku kwivuza kwa Medicare bisanzwe, harimo ubushobozi bwo gukomeza ubuvuzi bwo gukiza uburwayi burundu.

Impamvu zishingiye ku kwirinda bushake:

• Umuganga ashaka kugerageza uburyo bushya bwo kuvura bwashyize mu bikorwa.

• Umuryango cyangwa umuganga ahindura ibitekerezo ku buryo bwa hospice.

• Umuganga ashaka gukoresha ubuvuzi buharanira gukiza.

• Kwimurwa mu cyicaro kitajyanye na hospice (iby'ubuhanga).

Kugirango uhagarike, shingira ku kigero cyo guhagarika hamwe n'ikigo cyawe cya hospice. Guhindura kwivuza birakomeza ako kanya. Umunsi wahagaritsweho niwo munsi wa nyuma wawe w'igihe cyo guhabwa serivisi. Iminsi yakoreshejwe irazishyura serivisi yawe yose (niyo wahagarika ku munsi wa 30 w'igihe cya mbere cyo guhabwa serivisi, wakoresheje 30 mu minsi 90 y'icyo gihe).

Urashobora kongera kwitoranya hospice nyuma. Kwitoranya kongera gutangira igihe gishya cyo guhabwa serivisi gikwiye ku miterere yawe icyo gihe.

Guhindura Abaforomo ba Hospice

Ufite uburenganzira bwo guhindura abakora hospice rimwe mu gihe cyose cyo guhabwa serivisi. Ibi rimwe na rimwe byitwa "kwimurwa" aho kuba kwirinda. Bitandukanye no kwirinda, kwimurwa ntibisubiramo umurongo wawe w'igihe cyo guhabwa serivisi.

Impamvu imiryango ihindura abakora hospice:

• Kutishimira ubuzima cyangwa uko bahana.

• Kwimurira mu karere gashya gakoreshwa n'ikindi kigo.

• Ibisabwa byihariye ku buryo bw'ubuvuzi bishobora kutazashyirwa mu bikorwa n'ikigo kiriho.

• Ibisabwa mu madini cyangwa mu muco by'abishyigikiye hospice ishingiye ku idini.

Kugirango winjire, shingira ku kigero cyo kwimurwa hamwe na hospice nshya. Hospice iriho iramenyeshwa kandi hospice nshya irafata. Nta gucika intege mu kwivuza.

Umupaka wa Hospice (n'impamvu utagukora)

Urashobora kumva tuvuga "umupaka wa hospice". Iri jambo rireba abakora hospice, atari abarwayi. Medicare yashyizeho umupaka w'inyongerwa buri mwaka ku kigo cya hospice gikoresheje uburyo bugaragaza ko Medicare izishyura ikigo kimwe cyane cyane ku mibare y'abarwayi gikoresha.

Uyu mupaka ukora ku buryo hospice isubiramo ibikoresho ariko ntibihagarika kwivuza ku muntu wese wujuje ibisabwa. Ubujyanama bwawe burashingiye ku miterere yawe y'ubuvuzi, aho kuba ku mishahara yawe y'ibanze ya Medicare.

Kuva 2026, ikigero cyo kwishyura hospice cyiyongereyeho 2.6%, kigatanga miliyoni 750 z'amadolari yongeweho mu gutera inkunga hospice mu gihugu hose. Imibare y'umupaka yiyongera.

Igihe cya Medicare Hospice: Iki Wakwitega kuri Buri Rugero

Ku miryango yegereye kwitoranya hospice, hano hari gahunda nyayo:

Icyo utateganya: Ikiganiro n'umuganga w'ibanze n'umuryango kubijyanye n'inyunganizi ya hospice. Ikigo cya hospice gitanga ubufasha bwo gusobanura kubuntu nta gahunda. Iri gihe ntacyo kitagira.

Kwitoranya: Umuganga cyangwa uhagarariye asinya Inyandiko yo Kwitoranya Hospice. Kwivuza gutangira ako kanya. Hospice yohereza icyemezo cyo Kwitoranya kuri Medicare mu gihe cy'iminsi 5.

Iminsi 90 ya mbere: Ibyo kwita bisanzwe. Itsinda rya hospice rishyiraho gahunda n'imibanire y'umuryango. Umuganga akunda kugabanya ibibazo n'ububabare bwe.

Umuno 90: Gusubiramo kwemeza igihe cya kabiri cyo guhabwa serivisi. Umuganga wa hospice arasubiramo. Umuryango usanzwe udasobanura iki nk'ikintu cyihariye.

Umuno 180: Hakenewe guhurana na muganga wigishobora kwemera igihe cya gatatu cyo guhabwa serivisi. Umuganga wa hospice cyangwa NP asura umurwayi mu minsi 30 mbere y'umunsi 180. Gusubiramo kwemeza birarangira.

Umuno 240, 300, 360, n'ibindi: Guhora guhurana buri minsi 60. Gukomeza ubuvuzi busanzwe.

Igihe cy'imperuka: Ubuvuzi buriyongera mu minsi y'imperuka (Service Intensity Add-On itanga kwishura kwa Medicare yiyongereyeho mu minsi 7 yanyuma). Ubufasha bwo kubabazwa bukomeza ku muryango kugeza ku mezi 13 nyuma yo gupfa.

Kugirango ubasobanure neza kubijyanye n'uburyo Medicare ikora, reba ubuyobozi bwacu bwo bwo kwita ku barwayi kwa Medicare n'ubwo bwo kwita ku barwayi ku rugo.

Ibibazo Bishobora Kubazwa Cyane

Hari igihe ntarengwa cy'amezi 6 kuri Medicare hospice?

Oya. "Amezi 6 cyangwa munsi" bivuga ubwoba busabwa kugirango uhabwe ubujyanama bwa mbere, aho kuba igihe ntarengwa cyo kubaho. Igihuje n'ubushobozi bw'umuganga wa hospice ko ukomeje kuba urwaye burundu mu gihe cyo guhabwa serivisi, kwivuza birakomeza ubuziraherezo. Bamwe abarwayi bahabwa hospice igihe kirekire cyane.

Biteho niba ndi muri hospice igihe kirekire cyane cy'amezi 6?

Kwivuza birakomeza budacika intege igihe gusubiramo kwemeza byemeza ko ukomeje kuba ikwiye. Nyuma y'umunsi 180 (intangarugero y'igihe cya gatatu cyo guhabwa serivisi), umuganga wa hospice cyangwa umuganga w'umuganga utwite agomba guhurana n'umuntu mu minsi 30 mbere ya buri gihe gishya cyo guhabwa serivisi kugirango yemeze ko ukomeje kuba ikwiye. Ubuvuzi bwa hospice bukomeza budacika.

Eshobora Medicare guhagarika kwishyura hospice hagati mu kwivuza?

Medicare ntihagarika hospice mu buryo bwihariye. Kwivuza birashobora kurangira niba: (1) umuganga wa hospice yasanze udahuje ibisabwa ku burwayi bwa burundu mugihe cyo gusubiramo kwemeza (kwivuza utarashize), (2) uhisemo guhagarika hospice, cyangwa (3) winjiye mu kigo kidafite hospice cy'uburwayi bwa burundu. Mu bihe byose, kwivuza kwawe kwa Medicare bisanzwe bikomeza ako kanya. Urashobora kongera kwitoranya hospice nyuma igihe imiterere yawe yagabanutse.

Kenshi Kanghe Hospice Ikora Gusubiramo Kwemeza?

Gusubiramo kwemeza bibaho mu ntangiriro ya buri gihe cyo guhabwa serivisi: ku munsi 90 (intangarugero y'igihe cya kabiri cy'iminsi 90), ku munsi 180 (intangarugero y'igihe cya mbere cy'iminsi 60), kandi buri minsi 60 nyuma yayo. Nyuma y'umunsi 180, gusubiramo kwemeza bisaba kandi guhurana n'umuganga wa hospice cyangwa NP mu minsi 30 mbere ya buri gihe gishya cyo guhabwa serivisi.

Eshobora guhindura abakora hospice niba ntishimye?

Yego, rimwe mu gihe cyose cyo guhabwa serivisi. U signs igikoresho cyo kwimurwa hamwe n'umukoresha mushya wa hospice, kandi bakwita ku buvuzi bwawe. Ibi bitandukanye no guhagarika hospice burundu. Kwimurwa ntibisubiramo umurongo wawe w'igihe cyo guhabwa serivisi cyangwa gutuma habaho igicike mu kwivuza.

Ni iki cyitwa kwivuza utarashize muri hospice?

Kwivuza utarashize bibaho igihe umuganga wa hospice yasanze udahuje ibisabwa ku burwayi bwa burundu. Ibi rimwe na rimwe bibaho kuko kwita ku barwayi neza kwishimikira imiterere y'umurwayi bihagije kugirango ubwoba bw'amezi 6 budakibaho. Ugaruka ku kwivuza kwa Medicare bisanzwe ako kanya. Urashobora kongera kwitoranya hospice nyuma igihe imiterere yawe yagabanutse. Kuri 17% by'abarwayi ba hospice baravurwa buri mwaka.

Icyo Wagombye Kumenya

Medicare yishyura ubuvuzi bwa hospice ubuziraherezo igihe cyose ukomeje kuba ikwiye ibisabwa ku burwayi bwa burundu. Serivisi ikora mu bihe bibiri by'iminsi 90 bikurikirwa n'ibihe by'iminsi 60 bitagira umupaka, hamwe no gusubiramo kwemeza bisabwa mu ntangiriro ya buri gihe. Nyuma y'umunsi 180, guhurana na muganga wa hospice cyangwa NP bikenerwa mbere ya buri gihe cyo guhabwa serivisi gikurikiraho. "Amezi 6" mu kwemererwa hospice yerekeza ku bwoba mu gihe cyo kwemeza, aho kuba igihe ntarengwa cyo kubaho. Abarwayi bashobora kwirinda bushake hospice igihe icyo ari cyo cyose kandi bakongera kwitoranya nyuma. Kwivuza utarashize bibaho kuri 17% by'abarwayi ba hospice igihe imiterere yabo yiyongereye hejuru y'ibisabwa kuri hospice. Kubijyanye n'ibisobanuro kubijyanye n'ibyo hospice ikubiyemo n'uko bikora, reba ubuyobozi bwacu bwo bwo kwita ku barwayi kwa Medicare n'ubwo Medicare.